Due to the legislative motions and prior delays to the ICD-10 compliance deadline, there are many healthcare organizations across the country that may not have made as much progress in preparing for the new medical coding set scheduled to begin on October 1, 2015. Even over the last few weeks, Representative Ted Poe (R-TX) introduced a bill into the House that called for putting an end to the ICD-10 transition altogether.

There has been a fair amount of speculation as to the need for the new medical codes throughout the political spectrum and the delays from the last two years have also brought many medical facilities to doubt whether the current ICD-10 compliance deadline will stand still.

The Journal of AHIMA reports that the ICD-10 delays have set back some organizations financially and led them to lose their momentum. Janis Leonard, RHIT, CCS, director of HIM at Albany Medical Center, told the source that any more pushback against the ICD-10 compliance deadline including a postponement would cause severe disruption and a monetary hit due to all of the funds the medical system invested in ICD-10 training among their staff.

Leonard said that if another delay to the ICD-10 compliance deadline were to occur, it “would be tough to re-engage.” The Albany Medical Center is working toward ensuring that ICD-10 conversion on October 1 is a go and that another postponement does not take place.

“Even the director of patient financial services sent a letter to our Congressmen recently again saying ‘do not delay,’ so we have our financial people as well as our coders engaged in that initiative,” Leonard told the news source.

Additionally, physicians at this particular organization have been supporting the transition toward ICD-10 coding from the beginning and are conducting ongoing documentation improvement initiatives.

Online modules are also being used to offer more training opportunities for medical coders to ensure they are prepared for the ICD-10 transition. In particular, more training information on medical terminology, pharmacology, anatomy, and physiology is being offered at Albany Medical Center to ensure coders will be able to handle the increased specificity of the ICD-10 diagnostic codes.

For more than a year, Leonard and her team focused on dual coding throughout the organization requiring coders to use both ICD-9 and ICD-10 for coding 10 percent of a workday’s cases. Additionally, weekly training sessions are offered where coders can use ICD-10 to code scenarios and review their work with an instructor.

When it comes to retaining a strong workforce of medical coders within a healthcare facility, Albany Medical Center focused on restructuring the career ladder and offering more incentives.

“When we did this, we based [the job positions] on new qualifications, credentials and experience, and we swaddled people into their new roles,” stated Leonard. “And more than half of coders received an increase in pay. We also provided a recruitment and a retention bonus that was paid out over two years with a work commitment of two years to incentivize our coders to stick around after ICD-10 [transition].”

Over the course of several years, the reports that I run have changed. Some I have stopped monitoring, others have morphed into new reports, and others have combined into one single report. Here are the reports that I suggest your practice run:

DAILY

The types of information you need to be reviewing on a daily basis are as follows:

1. Your rolling AR by days

By looking at 0-30, 30-60, 60-90, 90-120, and 120+ days, you will be able to see when your billing department is/is not posting aged A/R, and if they are following up on denials.

2. Your rolling A/R by clinic/payer/provider

If you have more than one clinic, it's good to keep an eye on that A/R in each specific facility and by each provider. If suddenly Medicare stops paying on a specific provider, you will be able to easily and quickly identify this, and figure out why they have stopped paying. This happens more often than you think.

3. Your Medicare payments

It is critical that you identify the exact date that Medicare stops paying you. You need to know this date when you call Medicare to ensure you are paid for any back amounts. Medicare has often delayed payments to providers over the past several years. By knowing this exact date, you are more likely to receive all payments due to you.

4. Your payments summary

This will allow you to review if your front-office staff are collecting and posting copays and coinsurances, as well as following up with posting insurance payments.

5. Your billed claims

It is imperative that you know if your claims are being billed out. There are always software systems that have issues and if there is no one checking to see if claims are being billed out, some may never be sent.

WEEKLY

The types of information you need to be reviewing on a weekly basis are as follows:

1. Any Medicare allowable summary reports

Is your practice and procedures bound by any Medicare caps or specific allowed amounts? It's very important that you are aware of these restrictions so that you do not miss out on being paid.

2. Any missed medical notes

Does your EHR program allow you to run reports that show any provider-missed medical notes and charges? This is critical in the reimbursement process.

MONTHLY

The types of information you need to be reviewing on a monthly basis are as follows:

1. Adjustments report

This is where you are going to identify any clinic errors, as explained in my last blog. Also, what types of adjustments are being made and if you agreed to those adjustments.

2. DSO (Days sales outstanding)

You will want to know how many days it takes for you to be paid, from the date the patient was seen to the date the payment was received and posted.

3. Clinic key metrics

• Patient visits

• New Patients

• Charges

• Inflow

• Adjustments

• Percent collections

• Number of statements mailed

• Timed units

• Charge per visit

• Pay per visit

4. Collections and 15-day letters

QUARTERLY

The type of information you need to be reviewing on a quarterly basis is as follows:

1. Total A/R review

How do you know your billing staff are following up on unpaid claims if you are not reviewing their work? By reviewing your AR, you have the final decision on what adjustments need to be made. Has your billing staff tried following up on an $18.34 secondary payment more than once? If so, you've already lost money on that claim. Consider this cleaning house on those types of claims.

ANNUALLY

The type of information you need to be reviewing on a annual basis is as follows:

1. Year-end review of all of the reports mentioned above

If you had goals set for the year, its time to look at your office performance versus your set of goals. Did you outperform over last year, or the year prior? By looking at years prior, you can review if your goals were on track.

Keep in mind that looking at your performance data is truly key in your overall success; even if you are just starting out. While it can seem a little overwhelming, don't give up and remain consistent with the monitoring process. It can truly make a difference in your overall bottom line.

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